Role Of Hyperbaric Oxygen Therapy Research Articles

Role of hyperbaric oxygen therapy in the treatment of periodontitis

Periodontitis is a multifactorial disease caused by pathogenic microorganisms but modified by host response and environmental factors. Most of microorganisms responsible for periodontal destruction are obligatory or facultative anaerobes. Hyperbaric oxygen therapy (HBOT) includes therapeutic administration of 100% oxygen under pressure, which has a deleterious effect on anaerobic microorganisms responsible for periodontal diseases. This review focuses on the role of HBOT as a therapeutic measure for individual with periodontal diseases.

Effects of hyperbaric oxygen therapy as hepatic preconditioning in rats submitted to hepatic ischemia/reperfusion injury.

To analyze the role of hyperbaric oxygen therapy as hepatic preconditioning in rats submitted to hepatic ischemia and reperfusion. Wistar rats were randomly divided into three groups: SHAM, rats submitted to surgical stress without hepatic ischemia and reperfusion, I/R, rats submitted to total hepatic pedicle ischemia for 30 min, followed by 5 min of reperfusion; HBOI/R, rats submitted to 60 minutes of hyperbaric oxygen therapy at 2 atm and immediately submitted to the experimental protocol of ischemia and reperfusion. Liver function was assessed by measuring serum alanine aminotransferase and aspartate aminotransferase, as well as mitochondrial function by determining states 3 and 4 of mitochondrial respiration, respiratory control rate and mitochondrial permeability transition (mitochondrial swelling). The results were analyzed by the Mann-Whitney test and all P-values <0.05 were considered significant. There were significant differences in serum aspartate aminotransferase values in groups SHAM vs. HBOI/R, I/R vs HBOI/R, alanine aminotransferase in groups SHAM and I/R; State 3 in SHAM groups vs. I/R, SHAM vs. HBOI/R, State 4 in I/R vs HBOI/R groups, respiratory control rate in SHAM vs I/R groups; mitochondrial swelling in SHAM vs. I/R groups, and SHAM vs HBOI/R. Hyperbaric preconditioning improved hepatic mitochondrial function and decreased serum markers of liver injury in the ischemia and reperfusion process.

The Role of Hyperbaric Oxygen Therapy in Crush Injuries

Hyperbaric oxygen therapy has been approved for primary or adjunctive care in 14 indications. A hyperbaric environment exists when a patient's whole body is physically exposed to 100% oxygen and pressure that is greater than one atmosphere absolute. Hyperbaric oxygen therapy works through the ideal gas laws and is effective as an adjunctive therapy in the treatment of crush injuries. Oxygen is considered a drug and can have contraindications and adverse effects. Hyperbaric therapy works through several different mechanisms in the crush injury. Effects of hyperoxygenation, reduction of edema, infection control enhancement, blood vessel and collagen formation, and reduction of free radicals and reperfusion injury help in healing in patient with crush injuries.

Clinical efficacy of HBOT(hyperbaric oxygen therapy) in the treatment of foot ulcers in elderly diabetic patient: our experience

Background The development of foot ulcers is a serious complication in elderly diabetic patients. Its treatment is based on the use of different techniques, but when they fail that often lead to limb amputation. The efficacy of treatment with HBOT in diabetic foot ulcer has been evaluated for more than 20 years, but its use has never become routine, its use is a reality that in recent years is increasingly consolidating, especially as an adjuvant to conventional therapies and the NPWT (Negative Pressure Wound Therapy ) and dermal substitutes. Many studies prove its validity, experimentally the beneficial effects consist in the improvement of tissue perfusion, inflammatory cytokines down-regulation, fibroblasts proliferation, edema reduction , angiogenesis promotion and collagen production, it is also proven by the years the favorable effect against infectious component of the lesion [1,2]. In particular, the hyperbaric oxygen increases the bactericidal activity and is particularly toxic to anaerobes [3]. In addition, many studies, including some meta-analyzes, documenting the positive role of HBOT in reducing the risk of amputation, although a recent meta-analysis it is clear the shortterm benefit, but for the long-term studies would be needed to be so designated such as to minimize any bias [4]5. In our center, we evaluated the use of hyperbaric oxygen therapy to reduce limb amputation risk. Methods This observational study, open-label short-term evaluated the clinical efficacy of this method integrated medical therapy, treatment of wound cleansing and debridement, and topical applications of hydrocolloids, alginates, polyacrylates and foams. After obtaining informed consents, 7 diabetic patients with foot ulcers (n = 7) were enrolled and treated with cycles of hyperbaric oxygen therapy (2.4 ATA) for a period of about 85 minutes for 5 days a week, during the period between January and September 2012, with follow-up until May 2013.Among the exclusion criteria we considered: patients with compromised bone and / or Charcot’s foot, Wagner class greater than III, non elegible patients for HBOT (AP chest X-ray, visit ENT, cardiological examination with ECG, laboratory tests to assess feasibility), then patients with severe impairment of arterial district in the affected arm. All patients have done foot X-ray and ECO Color Doppler of lower limb as preliminary study, which showed: four patients Wagner class II, Winsor index between 0.9 and 1, three patients Wagner Class III, with winsor pathological index. The treatment was carried out in two stages: at first, the patients were treated with medical therapy, surgical debridement, exudate management and stimulation of granulation and epithelialization with advanced wound dressings, wound swabs and orthotics , in a second time were matched HBOT cycles. The follow-up was done by clinical and biochemical controls with particular attention to the glycemic profile and obtaining optimal levels of glycated hemoglobin, and taking cilostazol tablets 100 mg, possibly associated with antiplatelets (cardioaspirin, clopidogrel). We established two outcome measures : 1) surgical healing of the lesions, 2) amputation (short-term assessment by the end of treatment until May 2013). * Correspondence: luciano.grimaldi@unina.it Department of Specialized Surgery, Division of Gastrointestinal Surgery Rehabilitation of Election and Emergency. “Federico II” University, Naples, Italy Full list of author information is available at the end of the article Grimaldi et al. BMC Surgery 2013, 13(Suppl 1):A26 http://www.biomedcentral.com/1471-2482/13/S1/A26

Hyperbaric Oxygen: Silver Bullet for Diabetic Foot Ulcers

Background: Hyperbaric Oxygen Therapy (HBOT) involves the administration of pure oxygen under high pressure conditions. HBOT is used as an adjuvant therapy for a variety of conditions; including chronic wounds, infections, stroke, tissue transplantation, anemia, cancer management, skin flaps & grafts, CO poisoning, air or gas embolism, decompression thickness, necrotizing fasciitis, crush injury, compartment syndrome, gas gangrene and autism. Objective: This prospective study was designed to evaluate the efficacy of HBOT as adjuvant treatment for diabetic foot ulcers in comparison to the conventional treatment. Patients and methods: This study comprised 82 diabetic patients, aged 38 to 72 years. Patients were randomized into two groups: Group A assigned to receive HBOT in combination with conventional wound care & group B received conventional wound care only for the treatment of diabetic foot ulcers. Outcomes were measured every week for 1st two months during the treatment period and then at three-month intervals for one year. Ulcers were graded using Wagner classification system. Both groups were compared as regards healing time, need of amputation, quality of life. Results: The demographic characteristics of the 82 patients were 28 women (34%) and 54 men (65.9%), age range from 32 to 72 years. The median ulcer duration for both groups was 7.2 months, and the median ulcer area was 3.5 cm2. There was non-significant difference between both groups as regard demographic characteristics. Complete healing of the index ulcer was significantly faster in hyperbaric group 50% in comparison to 29% in group B. 2 major amputation were performed in HBOT group as compared to 3 cases in group B; all of them were Wagner grade IV. Five minor amputations were performed in each group during the 1st year of follow up. 63% of group A were satisfied as regard the management of their ulcers in comparison to 41% in group B. Conclusion: This study supports the role of HBOT as an adjuvant in healing of diabetic foot ulcers & improving quality of life.

Role of hyperbaric oxygen therapy in severe head injury in children

Aim:A brain injury results in a temporary or permanent impairment of cognitive, emotional, and/or physical function. Predicting the outcome of pediatric brain injury is difficult. Prognostic instruments are not precise enough to reliably predict individual patient's mortality and long-term functional status. The purpose of this article is to provide a guide to the strengths and limitations of the use of hyperbaric oxygen therapy (HBOT) in treating pediatric patients with severe brain injury.Materials and Methods:We studied total 56 patients of head injury. Out of them 28 received HBOT. Only cases with severe head injury [Glasgow Coma Scale (GCS) < 8] with no other associated injury were included in the study group. After an initial period of resuscitation and conservative management (10–12 days), all were subjected to three sessions of HBOT at 1-week interval. This study group was compared with a control group of similar severity of head injury (GCS < 8).Results:The study and control groups were compared in terms of duration of hospitalization, GCS, disability reduction,and social behavior. Patients who received HBOT were significantly better than the control group on all the parameters with decreased hospital stay, better GCS, and drastic reduction in disability.Conclusion:In children with traumatic brain injury, the addition of HBOT significantly improved outcome and quality of life and reduced the risk of complications.

Role of Hyperbaric Oxygen Therapy in Management of Complicated Case of Fournier Gangrene to Improve Patient Outcome

Fournier’s Gangrene is a life threatening urosurgical emergency and a synergistic gangrene of scrotum. It is a rapidly progressive & devastating form of necrotising fasciitis of perinal, perineum and genital area associated with high mortality and morbidity. Radical surgical debridement, broad spectrum antibiotics, negative pressure wound dressings and hyperbaric oxygen therapy are considered to be the cornerstone of treatment and contribute to improved outcomes. We present a case of Fournier Gangrene in a 57 Year old male patient complicated by presence of rare multiple microbial which was successfully managed with early diagnosis, prompt measures and use of hyperbaric oxygen.

Effects of Repetitive Hyperbaric Oxygen Treatment in Patients with Acute Cerebral Infarction: A Pilot Study

The role of hyperbaric oxygen therapy (HBOT) in the treatment of acute ischemic stroke is controversial. This prospective study assessed the efficacy and safety of HBOT as adjuvant treatment on 46 acute ischemic stroke in patients who did not receive thrombolytic therapy. The HBOT group (n = 16) received conventional medical treatment with 10 sessions of adjunctive HBOT within 3–5 days after stroke onset, while the control group (n = 30) received the same treatment but without HBOT. Early (around two weeks after onset) and late (one month after onset) outcomes (National Institutes of Health Stroke Scale, NIHSS scores) and efficacy (changes of NIHSS scores) of HBOT were evaluated. The baseline clinical characteristics were similar in both groups. Both early and late outcomes of the HBOT group showed significant difference (P ≤ 0.001). In the control group, there was only significant difference in early outcome (P = 0.004). For early efficacy, there was no difference when comparing changes of NIHSS scores between the two groups (P = 0.140) but there was statistically significant difference when comparing changes of NIHSS scores at one month (P ≤ 0.001). The HBOT used in this study may be effective for patients with acute ischemic stroke and is a safe and harmless adjunctive treatment.

Delayed hyperbaric oxygen treatment after acute carbon monoxide poisoning

Carbon monoxide (CO) is a colorless, odourless, highly toxic gas [1]. The diagnosis of CO-poisoning depends mainly on the history of exposure [2]. Carboxyhemoglobin reduces the oxygen-carrying capacity of blood, causing hypoxia [1–4]. After a period of apparent recovery, survivors of acute CO-poisoning can develop a potentially permanent neurologic deterioration (DNS) [1–3, 8]. DNS is a rare, poorly known encephalopathy with a 1–47% prevalence among CO-poisoned patients [5, 6]. Its symptoms and signs range from subtle abnormalities to severe dementia, parkinsonism, gait disturbances, mutism, and incontinence [1, 2]. Appropriate therapy for DNS is widely debated; particularly, the role of hyperbaric oxygen therapy (HBO2) is controversial. We describe a patient suffering from a striking neurologic decline after complete recovery from severe COpoisoning, who recovered after delayed HBO2 treatment. A 62 year old man was admitted to our hospital after having developed an akinetic-mute state with stereotyped movements, incontinence, gait-disturbances and cognitive deterioration over a period of 2 weeks. Twelve days before symptom’s onset, he was found unconscious in his smokefilled flat. He underwent intubation and high-flow oxygen therapy was provided. The cranial computerized tomography (TAC) which was immediately performed was normal, while after a few days it revealed symmetric hypodense globus pallidus (GP) lesions. He regained consciousness after 1 day. A week later he was asymptomatic and his neurological condition was unremarkable. Back home he returned to his normal activities. However, 12 days later he developed confusion and memory disturbances. His neurologic state began to deteriorate rapidly, progressing to akinetic mutism over the next week. He became totally unresponsive and incontinent. When he was referred to our hospital he showed a severe speechimpairment, with very poor expression and comprehension, dysarthria, and apraxia, also involving the cranial district. He was hypomimic, and he presented stereotyped movements, especially with his hands. His tone was markedly increased, standing and gait had become severely affected (Video Segment-1 of electronic supplementary material). Neuropsychological testing revealed severe dysfunction in all cognitive domains. Diffuse white matter (WM) hyperintensities, also involving the corpus callosum, were seen on T2-weighted MRI scans, accompanied by bilateral GP collapses (Fig. 1). A diagnosis of delayed encephalopathy after CO-intoxication was made. HBO2 therapy was carried out every day for 10 days at 2.5 absolute atmosphere (ATA), each session lasting 70 min, with gradual and progressive clinical improvement starting since the very first sessions of HBO2 therapy. After the treatment, the patient’s neurological state was unremarkable, with only Electronic supplementary material The online version of this article (doi:10.1007/s00415-011-5958-4) contains supplementary material, which is available to authorized users.

Use of Adjuvant Hyperbaric Oxygen Therapy to Support Limbal Conjunctival Graft in the Management of Recurrent Pterygium

To assess the role of hyperbaric oxygen therapy (HBOT) in the management of recurrent pterygium. Thirty-nine eyes with recurrent pterygium were treated with surgical excision and limbal conjunctival autograft, followed by a course of HBOT. Patients were followed for development of recurrence. Of the 39 eyes, 18 had a known history of exposure to beta radiation or mitomycin C. The mean duration of follow-up in this group was 23.1 months. A single recurrence was noted in this group. For the remaining 21 eyes, the mean duration of follow-up was 19.4 months. No recurrences were recorded in this group. No significant complications from HBOT were recorded. The use of HBOT together with excision and limbal conjunctival autograft for recurrent pterygium is associated with a low recurrence rate. Adjuvant HBOT should be considered in the surgical management of recurrent pterygium.

Hyperbaric Oxygen Therapy as an Adjunct to Surgical Treatment of Extensive Hidradenitis Suppurativa

We appreciate the comments by Uzun et al. [1]. In our series, we did not consider the option of hyperbaric oxygen therapy (HBOT) because we did not experience any serious wound complications. This was due to the meticulous wound care carried out in our clinic. We also did not experience any recurrences [2]. In cases of serious woundsite infections, however, HBOT may be an alternative treatment, although it should always be accompanied by surgery and intensive surgical wound care [1]. Apart from wound-site infections, this modality can be considered for the purpose of shortening the wound-healing period for patients whose wounds are left open for secondary intention. In our study, despite the 2-week mean healing period for the rotation flap group, the mean healing times of the patients who were treated with skin grafts and secondary intention were 8.0 and 12.2 weeks, respectively (almost 2 and 3 months, respectively) [2]. This prolonged healing period might have been avoided had the enhanced wound-healing effects of HBOT mentioned by Uzun et al. [1] been applied. We can see that there is a lack of data in the literature concerning the use of HBOT as an adjunct to surgery in such cases and agree that the role of HBOT in hidradenitis suppurativa cases should be researched in a randomized controlled trial.

Role of hyperbaric oxygen therapy in sudden sensory neural hearing loss (SSNHL)

Role of hyperbaric oxygen therapy in sudden sensory neural hearing loss (SSNHL)

The role of hyperbaric oxygen therapy in trauma

This review explains the method of action of hyperbaric oxygenation (HBO) therapy and examines the evidence for its use in trauma. Methods of delivery, complications and contra-indications are discussed. It is acknowledged that there are few controlled trials which evaluate the efficacy of HBO in this indication; supporting evidence for its efficacy is mainly in the form of case reports, or by implication from laboratory and animal work. Lack of evidence may not equate to lack of efficacy, but may reflect the difficulties in coordinating clinical trials involving critically ill patients and a complex treatment modality, the availability of which is not widespread. The adjunctive use of HBO has shown promising results in the treatment of crush injury. Consideration of tissue pathophysiology suggests that such an approach may also offer improved outcomes in the broader spectrum of trauma scenarios involving marginally viable tissues with compromised perfusion.

Hyperbaric Oxygen Therapy as an Adjunct to Surgical Treatment of Extensive Hidradenitis Suppurativa

We appreciate the comments by Uzun et al. [1]. In our series, we did not consider the option of hyperbaric oxygen therapy (HBOT) because we did not experience any serious wound complications. This was due to the meticulous wound care carried out in our clinic. We also did not experience any recurrences [2]. In cases of serious woundsite infections, however, HBOT may be an alternative treatment, although it should always be accompanied by surgery and intensive surgical wound care [1]. Apart from wound-site infections, this modality can be considered for the purpose of shortening the wound-healing period for patients whose wounds are left open for secondary intention. In our study, despite the 2-week mean healing period for the rotation flap group, the mean healing times of the patients who were treated with skin grafts and secondary intention were 8.0 and 12.2 weeks, respectively (almost 2 and 3 months, respectively) [2]. This prolonged healing period might have been avoided had the enhanced wound-healing effects of HBOT mentioned by Uzun et al. [1] been applied. We can see that there is a lack of data in the literature concerning the use of HBOT as an adjunct to surgery in such cases and agree that the role of HBOT in hidradenitis suppurativa cases should be researched in a randomized controlled trial.

Effects of hyperbaric oxygen therapy after spinal cord injury: systematic review

OBJECTIVE: to conduct a systematic review of experimental and clinical studies evaluating the effect of hyperbaric oxygen therapy on the spinal cord injury. METHODS: ninety-three studies were identified in the database Pubmed. Among these, through a set of inclusion/exclusion criteria, 11 articles published between 1963 and 2009 were selected. In the nine experimental studies, different ways to apply the treatment were observed. The measured outcomes were: functional, histological, biochemical and electrophysiological. RESULTS: in most of the studies, the results show recovery of locomotor function, histology and/or biochemical features. Regarding the two studies in clinical samples, the results are controversial. The samples are heterogeneous and the application of hyperbaric oxygen therapy is not the same for all patients in each study. CONCLUSION: considering the results of this review, further studies are necessary to define the role of hyperbaric oxygen therapy in acute spinal cord injury.

Role of hyperbaric oxygen therapy on survival and engraftment of stem cells in the infarct heart

Role of hyperbaric oxygen therapy on survival and engraftment of stem cells in the infarct heart

Book review

WOUND CARE PRACTICE , SECOND EDITION , TWO VOLUMES–47 CHAPTERS . PAUL J SHEFFIELD AND CAROLINE E FIFE , 2007 , BEST PUBLISHING COMPANY , 1210 PAGES . ISBN: 1-930536-380 . PRICE:$189 . This book is written by 65 different authors who range from a variety of medical/surgical backgrounds and professions with the majority being USA-based clinicians. There are 47 chapters spread across two volumes, and it is a comprehensive resource for practitioners caring for patients with wound healing problems. In the authors' own words, the book evolved from an underlying interest in the role of oxygen in wound healing. This interest is apparent in many of the chapters in both volumes, but there are also chapters dedicated to other wound care topics of a more general nature. Much of the content related to the management of wounds is based on local practice and opinion; however, many of the authors have attempted to include National guidance and current evidence where appropriate. Overall, the book is aimed at practitioners working in the USA or countries that follow a similar form of health care service delivery, therefore clinicians outside of this would need to bear this in mind when assimilating the information into their own clinical practice. Furthermore, newer government guidance such as the new National Pressure Ulcer Advisory Panel (NPUAP) Pressure Ulcer Staging System (1) has not yet been included in the relevant chapters. Many of the chapters are written by recognised experts in the field of wound care and it is interesting to see the diversity of contributors and topics. The book is divided into six sections and the editors have tried to include every aspect of managing a patient with a wound. Section 1 examines what a chronic or ‘problem’ wound is and introduces the reader to the wound healing process, which is well described and supported by informative illustrations. Section 2 considers the requirements of both patient and wound assessment and evaluates non invasive methods of assessment, here the focus tends to be on transcutaneous oxygen tension (TcpO2). There is also a useful overview of how to search for evidence using a case study as an example. Section 3 considers the principles of wound management with 14 chapters dedicated to a range of wound types and interventions. Each chapter deals with a separate aspect of management and there is minimal overlap in the topics. However, the role of debridement and oxygen does feature in a number of them as one might expect. This section concludes Volume one. Volume two commences with an overview if wound healing across the span of ages and also introduces a novel chapter which the author has called, Prevention: The sixth phase of wound healing. Section 4 Pain, infection and adjunctive therapies explores a range of topics which the title does not necessarily reflect, that is nutrition and hydration and glycaemic control in diabetics are included. Therefore, the reader needs to consider the chapter headings carefully to avoid overlooking some of the more interesting aspects of this section. Section 5 outlines the ethical and legal aspects of providing wound care and is written with those providing hyperbaric oxygen therapy (HBOT) in mind. Section 6 deals with issues of service delivery and establishing a wound care centre to include reimbursement issues. Again this is focussed on those providing HBOT. A useful component of the book is that all chapters have multiple-choice questions at the end for the readers to test their knowledge. Interestingly, the answers are provided at the bottom of the page rather than in an appendix so the reader may be tempted to look at the answers rather than really testing themselves. In addition some, but not all, chapters have divided their reference list into the various subtopics addressed. This is a very useful feature for the reader as it would help to save time for those wishing to follow up on the primary sources of evidence. There are many examples of treatment pathways or protocols that the reader may find useful and the use of colour images enhances the overall presentation. The book is written in an easy-to-follow style and would appeal to novice practitioners who may be exploring new areas of knowledge or experienced clinicians seeking to extend their current practice or indeed seeking to set up their own HBOT wound care centre. For those seeking a general introduction to the breadth of wound management practices, this would provide a useful resource. For those wishing to delve deeper into the role of HBOT, then this would be an excellent starting place. Samantha Holloway, RGN, MSc 1

Role of hyperbaric oxygen therapy in the treatment of bacterial spinal osteomyelitis

Hyperbaric oxygen therapy (HBO) is used as primary and/or adjunctive therapy in the treatment of various clinical conditions complicated by local hypoxia. It may have therapeutic potential in the treatment of neurosurgical infections such as spinal osteomyelitis that are associated with significant morbidity rates. The purpose of this study was to evaluate the efficacy of HBO therapy in the treatment of spinal osteomyelitis. The clinical records of patients diagnosed with spinal osteomyelitis who received HBO therapy during their treatment at the authors' institution over the past 10 years were retrospectively reviewed. Six adult patients were identified. Four patients had recently undergone spinal surgery and secondary spinal osteomyelitis had developed. These patients received adjunctive HBO therapy due to significant comorbidities and risk factors for poor healing. All patients remained symptom and infection free over the subsequent follow-up period. Two patients had primary spinal osteomyelitis that had recurred despite a full course of appropriate antimicrobial therapy. Infection control was achieved after HBO therapy in 1 patient. The mean follow-up period for the study group was 2.9 years (range 5 months to 5 years). Hyperbaric oxygen therapy enabled infection cure in 5 of 6 patients with spinal osteomyelitis complicated by medical comorbidities or the failure of primary therapy. These results show that HBO may be a useful adjunctive therapeutic modality in the treatment of spinal osteomyelitis, particularly when there are medical comorbidities that increase the risk of poor healing. Hyperbaric oxygen therapy may also be beneficial in patients with relapsing primary spinal osteomyelitis after standard therapy has failed.

Hyperbaric Oxygen as Adjunctive Therapy in Experimental Mediastinitis

Mediastinitis is a dreaded complication of cardiac surgical procedures. The purpose of our study was to research the role of hyperbaric oxygen therapy (HBO) in the treatment of experimental mediastinitis and to investigate whether it potentiates the antibiotic effects of linezolid, teicoplanin, and vancomycin. The study included nine groups; an uncontaminated and a contaminated untreated control groups, and seven contaminated groups that received HBO or systemic antibiotics with linezolid, vancomycin, or teicoplanin, or a combination therapy consisting of one of these antibiotics and HBO. There were six adult male Wistar rats in each group. Contaminated groups were inoculated with 0.5 mL 10(8) CFU/mL methicillin resistant Staphylococcus aureus in the mediastinal and in the sternal layers. The antibiotic treatment continued 7 d. Twelve hours later at the end of the treatment, the rats were sacrificed, a sternotomy was performed for each rat and tissue samples from the upper ends of the sternum were aseptically obtained and evaluated microbiologically. There was no difference between the therapeutic efficacy of linezolid, teicoplanin, or vancomycin (P>0.05). When the groups were analyzed separately, treatment with a combination of HBO and antibiotic therapy reduced the bacterial count in comparison with HBO or antibiotic treatment alone (P<0.05). The combination of teicoplanin or vancomycin and HBO, respectively, was not more effective in reducing the bacterial count in comparison with the combination of linezolid and HBO (P>0.05). Linezolid and teicoplanin therapy was found as effective as standard vancomycin therapy for methicillin resistant Staphylococcus aureus (MRSA) mediastinitis. Adjunctive HBO offered additional benefit to the antibiotic treatment of mediastinitis.

Arterial Gas Embolism: A Review of Cases at Prince of Wales Hospital, Sydney, 1996 to 2006

Arterial gas embolism may occur as a complication of diving or certain medical procedures. Although relatively rare, the consequences may be disastrous. Recent articles in the critical care literature suggest the non-hyperbaric medical community may not be aware of the role for hyperbaric oxygen therapy in non-diving related gas embolism. This review is part of an Australian appraisal of experience in the management of arterial gas embolism over the last 10 years. We identified all patients referred to Prince of Wales Hospital Department of Diving and Hyperbaric Medicine with a diagnosis of arterial gas embolism from 1996 to 2006. Twenty-six patient records met our selection criteria, eight iatrogenic and 18 diving related. All patients were treated initially with a 280 kPa compression schedule. At discharge six patients were left with residual symptoms. Four were left with minor symptoms that did not significantly impact quality of life. Two remained severely affected with major neurological injury. Both had non-diving-related arterial gas embolism. There was a good outcome in the majority of patients who presented with arterial gas embolism and were treated with compression.